Special considerations in elderly individuals with urinary incontinence

To describe special considerations related to the etiology, evaluation, and treatment of urinary incontinence (UI) in the elderly.

The characteristics of UI in older patients are contrasted with those in younger patients. Recommended evaluations for elderly individuals are reviewed, and treatment issues are addressed.

The etiology of UI is more complex in older than in younger patients, and a different clinical approach is required. Bladder overactivity is a common underlying component of UI in the elderly patient regardless of the complexity of the etiology. The most common voiding symptom in elderly patients is urgency with urge UI. The evaluation of the older patient with UI should include a symptom assessment, physical examination, review of the medical history (particularly with regard to previous surgeries), and assessments of social environment and functional status (which can have an impact on the type of treatment selected and the success of therapy). Urodynamic evaluations are particularly important because of the complexity of UI in this population. Treatment options include pharmacologic therapies, behavioral interventions, electrical stimulation, and combination therapies. The combination of surgical and nonsurgical therapies may be particularly important in the future.

Control of bladder overactivity is the most significant long-term challenge in the management of UI in the elderly. Successful treatment can produce a marked improvement in the quality of life for these individuals.